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Investigating Neurocardiac Autonomic Regulation and Cortical Excitability Measures in Patients with Major Depressive Disorder

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Abstract

Major depressive disorders (MDD) are among the most common psychiatric disorders affecting people worldwide. The steady increase in cases of depressive disorders has been mainly attributed to enhanced life stress. The association of this clinical condition with other systemic disorders, especially cardiac conditions, raises concerns about increased morbidity and mortality related to this disorder. Investigating neuro-cardiac regulation using heart rate variability (HRV) and cortical excitability using transcranial magnetic stimulation (TMS) in patients with depression can provide crucial insights to understand systemic involvement and possible therapeutic interventions. We recruited 60 patients suffering from moderate depression based on International Classification of Diseases ICD-10 criteria on treatment with Escitalopram for more than 2 months. The HRV measures and TMS techniques using cortical excitability measures with single and paired-pulse TMS measures were performed on all the patients and compared with age- and gender-matched healthy controls. Patients with depression showed significantly lesser standard deviation of normal-to-normal interval (SDNN), root mean square of successive differences (RMSSD), total power (TP), high frequency (HF) power, and increased low frequency (LF) power and LF/HF ratio which together indicate reduced HRV. Reduced short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP) (assessed by TMS) were also observed in patients with depression compared to healthy controls. Patients with depression showed decreased HRV, glutamatergic activity, gamma amino butyric acid-B (GABA-B) activity, and increased GABA-A activity. These findings suggest aberrant neuro-cardiac regulation and cortical excitability in this enigmatic disorder.

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Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors would like to acknowledge the support of CCRAS (Central Council for Research and Ayurveda Sciences) for providing fellowship to the first author (JVS) and the DST SERB grant (EMR/2015/000209) which enabled us to collect healthy control data.

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Authors and Affiliations

  1. Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560 029, India

    V. S. Jismi, Talakad N. Sathyaprabha & Kaviraja Udupa

  2. Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560 029, India

    Kishore Kumar Ramakrishna & Shivarama Varambally

  3. Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560 029, India

    Urvakhsh Meherwan Mehta & Shivarama Varambally

  4. Consciousness Studies Program, National Institute of Advanced Studies (NIAS), Bangalore, 560012, India

    Urvakhsh Meherwan Mehta

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  1. V. S. Jismi
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  3. Urvakhsh Meherwan Mehta
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Contributions

JVS collected and analyzed neurophysiological data and drafted the initial manuscript taking inputs from all the authors; KKR, UM, SSV, STN, and KU provided the supervision. All authors read, edited, and approved the final manuscript.

Corresponding author

Correspondence to Kaviraja Udupa.

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Ethics Approval

The study was carried out in the Department of Neurophysiology in collaboration with Dept of Psychiatry, NIMHANS. The Institute Ethics Committee approval was obtained for the study (NIMHANS/HECCAIM meeting/2020–21 Dated 15.12.2020) and this study was registered under the Clinical Trial Registry of India (CTRI/2021/01/030417 dated 12.01.32021).

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Written informed consent and assent were obtained before recruiting the subjects for the study.

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The authors declare no competing interests.

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Jismi, V.S., Ramakrishna, K.K., Mehta, U.M. et al. Investigating Neurocardiac Autonomic Regulation and Cortical Excitability Measures in Patients with Major Depressive Disorder. SN Compr. Clin. Med. 6, 44 (2024). https://doi.org/10.1007/s42399-024-01674-6

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